Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 7769 | CT |
NPI | 1033580337 |
---|---|
Provider Name | Sonila Alickolli |
First Address | Waterbury, CT 06706-1748 |
Second Address | Waterbury, CT 06706-1748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2015 |
Last Update Date | 13/10/2015 |